Incarcerated and Strangulated Hernias in Children: A Statistical Study of High-Risk Factors
TL;DR: Incarceration and strangulation of the commonplace indirect inguinal hernia is still a significant management problem in children and the influence of age, side involved, sex, race, delay in, and method of management in the outcome has been statistically evaluated.
Abstract: Incarceration and strangulation of the commonplace indirect inguinal hernia is still a significant management problem in children. We have studied a series of 2,764 consecutive patients operated upon for hernia at the Columbus Children's Hospital. Three hundred and fifty-one hernias or 12.7% were incarcerated or strangulated or both at the time of admission. The influence of age, side involved, sex, race, delay in, and method of management in the outcome has been statistically evaluated.
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TL;DR: The results have not corresponded with previous teachings and myths: (1) a hernia of a premature baby should be fixed sooner than later; (2) routine contralateral groin exploration is not indicated in any situation; and (3) teenage recurrence rate is 4 times greater than the overall series.
273 citations
Cites background or result from "Incarcerated and Strangulated Herni..."
...Our younger premature incarceration mean age of 1.5 years equaled that of Rowe and Clatworthy [20] in their series....
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...This small incidence (0%-19%) was not always found by other authors [3,8,9,16,20,39,42]....
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...5 years equaled that of Rowe and Clatworthy [20] in their series....
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...Moreover, the 9% incarceration rate of females in our series was less than the 17% reported by Rowe and Clatworthy [20] in their large review....
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TL;DR: In this paper, the authors used meta-analysis to diagnose a contralateral patent processus vaginalis in children undergoing unilateral inguinal herniorraphy using laparoscopy.
160 citations
TL;DR: Evaluated predisposing factors, presentation, and postoperative complications in 100 recent consecutive hernia repairs in previously hospitalized infants less than 2 months of age, finding no cause for concern about timing and safety of early repair.
146 citations
TL;DR: Most elective repairs of hernias are safely performed in the outpatient setting; however, some infants and children with concurrent illnesses are best managed in a “morning admissions” program, in which hospital admission occurs postoperatively.
Abstract: Trends are changing in the management of infants and children with indirect inguinal hernias. Advances in neonatal intensive care have resulted in the survival of many small premature infants who have a high incidence of inguinal hernia. The rate of incarceration, strangulation, and gonadal infarction in these babies is twice that of the general pediatric age group. Respiratory immaturity, apnea, bradycardia, and associated neonatal conditions require special management at the time of hernia repair, usually performed just before discharge from the neonatal intensive care unit. New information concerning volume loss and depletion of germ cells beginning at 6 months of age in boys with undescended testes has stimulated the performance of orchiopexy when the patient is 1 year of age. More than 90% of boys with cryptorchid testes at the age of 1 year have an associated hernia that requires concomitant repair at the time of orchiopexy. The use of the peritoneal cavity for fluid absorptive purposes in hydrocephalus treated by venticuloperitoneal shunts or of peritoneal dialysis for renal failure and metabolic diseases such as hyperammonemia and lactic acidosis causes increased intraabdominal pressure and results in the appearance of a previously unrecognized hernia. Recognition of these and other conditions associated with a high incidence of hernial occurrence should allow early diagnosis and treatment before the development of complications. Most elective repairs of hernias are safely performed in the outpatient setting; however, some infants and children with concurrent illnesses are best managed in a "morning admissions" program, in which hospital admission occurs postoperatively.
145 citations
TL;DR: It is concluded that incarceration is a preventable problem in children awaiting elective operation for an inguinal hernia and patients scheduled for hernia repair are at risk and the operation should be performed soon after the diagnosis is made.
108 citations
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TL;DR: A large series of children with inguinal hernias operated upon by one group of surgeons, in a single hospital, were studied to determine the natural history of the patent processus and determine the factors that might be associated with patency of the processus.
224 citations
Journal Article•
155 citations
TL;DR: Gertrude Herzfeld pointed out that indirect inguinal hernias were simply congenital defects associated with a persistent patency of the processus vaginalis and advocated performance of an elective herniorrhaphy at the time of first appearance of a hernia in all otherwise healthy infants.
Abstract: IN 1938, Gertrude Herzfeld, Honorary Surgeon of the Royal Edinburgh Hospital for Sick Children, reviewed her experience with 1,000 cases of indirect inguinal herniorrhaphy in infants. 1 In so doing, she detailed certain techniques and methods of management that are worthy of reemphasis today. Herzfeld pointed out that indirect inguinal hernias were simply congenital defects associated with a persistent patency of the processus vaginalis. She also appreciated the difficulties of conservative management with trusses and the inherent danger of incarceration facing a young infant. This realization led her to advocate performance of an elective herniorrhaphy at the time of first appearance of a hernia in all otherwise healthy infants. Herzfeld's operative technique was a simple one, learned as a student of Sir Harold Stiles and his accomplished assistant, Sir John Fraser (written communication, 1966). Exposure through a small transverse incision was followed by opening the coverings of the cord at
29 citations